Loading...
HomeMy WebLinkAboutBuilding Permit #825-2017 - 50 HIGH STREET 3/1/2017t%ORTh► BUILDING PERMIT OF'ItLeu 6;��c tip �2 yyYt,— ..•.eh. 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7N :y G �1 ` Date Received Oermit No#• ��"OR�rRP �pR�gg [Date Issued. PORTANT: Applicant must complete all items on this page i LOCATION Y'- 2 M I 1 I n Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District no Machine Shop Village IEDno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: VgCommercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Vllell ❑Floodplain ❑Wetlands ❑ Watershed, Drstnct Watei/Sewer - DESCRIPTION OF WORK at 4 e UCI" a nH0-ncci, OWNER: Address: z CQ0-T Z IKi G Iti ,m 1 Contractor Name:"q> A Email: K e S ru,e-,J Address: Su , G'6 ( J BE PERFORMED: S if M e&- p- ,ntif ation - Please Type or Print Clearly ' Pho r+1 Phone: b 17- I l /1f7 He 2,5--e2 fJ 0 Z 14-3 e: 61"7 -VII Fop, e-orelL n lon a VL-^- NA l Supervisor's Construction License: d (3 6 22 4-- Exp. Date: c? 2_ 6 f - 4 Home Improvement License: Date: ARCHITECT/ENGINEER W.°c-tt^-LqT lvqc- Phone: R2��''2.`�`�T o Address: 5 _w R se, -y NJ fie , A d 1 q � 9 Reg. No. FEE SCHEDULE: BUILDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 2-; 21 S- FEE: $ 4M I Check No.: Receipt No.: NOTE: Persons contract ng w th unregistered contractors do not have access ro the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION Reviewed on \ S COMMENTS HEALTH Reviewed on / Si COMMENTS Signature, Zoning Board of Appeals: Variance, Petition No: _7:1Zoning ecision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea 3d4 US9000 Street •i—.,wa+.+.. ws...rw.�.c•r*".7 ...^ ^-t'c '3`Y L*I:w t �*"'* 5 .,.s"S,a � �'.y "r - �---•y`-"�e+�-.--"`. - - --- -'- 1EIRE DEPAR+TMEN1Tq�: erne Dumpster onsite `,es �� , inoa Lo ted at 12 ° " xt4 Maint�eetN; l ", Fire De artmentgrafure/date _ tP... �. }} �iivat �! .�,.Px , . u, � c 5�,. F, q ..� _ �+ t. 'pi' r.a ,�i• .. + . .. }S P Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: lyres MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4� Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) � Engineering Affidavits for Engineered products . TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of. H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4� Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the, building application Doc: Building Permit Revised 2014 Location �.f No. �) I '// Date 1 l Check # TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ .. Other Permit Fee $ ti TOTAL Building Inspector W c CL n rt U) c m CL O n m z m m co) Cl) W nM =O 0 me 110 Nrn Cl) —qD co �— mgo ou.-I CN r� vM O� n(D 0.11 000 m -o n� Z 0° vK) V) tv c� n� z OD m n XO my OD rn >m z� Cl)_ n� �m D� ;<0 O M< T �O m O m m 00 c r v z r O n m v z 0 cn q X m m CD C Q 7 (a T CD 3 z 3 cr CDn co N CJ7 D N O CD O N O V 0 T CD z C 3 cr CD N 0) w 0 m �1 0 m O "n C cn m 90 O n 0 C Z 0 W c 0 m I n su m N N m M 0 z c z m cn m cn cn VI nm =O C n mC Nm cnv _qD mqcn - mgo CD --I CN r� v� z =' O� 0 O. vW m D0 Z00 vu co C� n H 0D m n �O my O D CZ r0 >m z� in D� cn = �m D� D O 'UN �O m O In m _ m W c v z r n m v z 01 0 cn -I m m m 1 71 _ =i W c _Q 7 (a T CD 3 z 3 cr CD 00 N U1 D N O 0 w 0 T CD 3 z 3 0 - CD n N U7 rn 0) w 0 m 0 m O mn C m 90 O 0 n C D Z 0 rn rn 0 V 3 flI 3 0 v 3 O U) d ou S, to 0 0 n CD I CD N N c c� Q 0 z 0) Z m cn m V/ W nM =O n mC q '0 Nm Cl) .-ID M -A — mgo M --I _cN I" Q v z =' O� n� O' v o0 m"U C Zco voi co 0 "4 _ OZ =n ;uO mD G) D r,n >m Z � c_ n� cn = �m D �O -v N �O m O n m _ m W c v z n v Z Ul 0 c� m m 0 X m _ 9 IML C a. 7 (a T CD 3 z 3 u CD 00 N D N O v 0 CD 3 z 3 0- cCD N ol M rn w ;*, 0 m I n m O TI C m 90 O 0 0 C Z 0 CO) Or.fZ CD O CL r Q �. 0!0 < v C c CD O O 0 y CD e� CD CDa c� N O O CD O CD Z m cn O Z < oo-0'" -I O C --% N _ C CDCD CL 0 CD 0 N O 0 Q' C) rt -IL CD O O r+ C. 0 m CD CD eq. cn m N W O E0 CD m 2 CL c� CL O CC N 0 O O O S CO') CD 03 CD CD A rn =' ° to to jC CD O o• "'. - Z D 0 c .� rn o �� N Q toCL 0 24o — o 0 Q ;m_• o rn Cl)CL `D CD 0 Ec Z O Cl)cc 0 O ID 'y C O C' CD CD 0 y n _O -04 - CD O C a) O O O C. Wk It Ln N W t C O N' r -r T mT O O 0) Oq S N p O N < C T ;0 N OOC S T Z7 T D1 C 7 •G N T �. Q n (D �1 �-j r •�� a `� rD S m rD Mo k N n V'i Sk W g z m O Get, m m LA m i m D � d 4 m i 3 ♦ 6's Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 232,576.00 m $ 2,790.91 Plumbing Fee $ 348.86 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 348.86 Total fees collected $ 3,588.64 50 High Street - I&T LLC 825A-2017 on 13/7/17 Tenant Fit up Q u=. O m N \ O LL E TO N U N N C ui Z Z .� m r "'a O LL t O d' - A C t U LL 0 w Z Z m J L O LL 0 a IA Z U U W t O d' U O (n O LL OF ui CL Z Q t O d' LL z CL W W 5 U. 7 m O z N N 0 Y O (n n O m yr - �C p v W r S V a did r : C w d 4) L � °� N 1 r Cc E V. :; .. 4U) > C O `cd cn o �-0 0 0 CA �� o 2 > cn C o — ; U)= o o � � O a, > c Q 0 o . �. -� 0) C - : o -0=.r_ 3 __ ~' L ta = m Q L _ O = d rL N 1- O to 2 m m CO) uj wLi -CA C N C O - V 14- V O W L V ._ �j0 am V Q d y Q tiG O O N � H t 4.. Q 0 V > 2 Z m ccZ W w a w H W CL ti N Z V U) J 0 E O Z CL O N O ._ N Q •E • . • • . CD CL O — A O �+ v D O o CL CL Q � Q O v J � �CL O Z O V tU Q. PROJECT NUMBER: 15-0718 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT TITLE: Internet & Telephone, LLC. PROJECT LOCATION: 50 Nigh Street, N. Andover, MA NAME OF BUILDING: West MITI NATURE OF PROJECT: Tenant improvement/fit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, L_) ALAejz_ REGISTRATION NO. 153 __ BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ' ARCHITECTURAL �} STRUCTURAL ° MECHANICAL FIRE PROTECTION ' ELECTRICAL ® OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CE=RTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. I 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally fa li r with6the jprogress and quality of the work and to determine, in general, if the work is h_ performed in a manner consistent with the construction documents. r1,5' PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGR TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER B L I R. I d •Lo a n 4;a UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AI§ T IjA fi SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR s A CY. �J crN or h�P SIGN_ff_ ( 1 SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF v 20 CHEZ RYL L. BURICINSHAW "7_1I Notary Public NOTARY PUB MY COMMISSI., XRIRES c-tta MY mmhssion Expo iter March 7, 2019 0 JK Contracting Inc. 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To RCG West Mill NA LLC Daviid Steinbergh 17 Ivaloo Street Somerville, MA 02143 Proposal Date: 2/20/2017 Proposal #: 203-90 Ship To IT, LLC - 2nd Floor North Andover, MA 01845 rrolect: 5U Hign 5t, 11, LL... Description Est. Hours/Qty. Rate Total Project Location/Description Hlgh St; iT, LLC, North Andover, MA Permit ,& C of 4 = 2,800.00. 2,800 00 Demo 1 5,000.00 5,000.00 'General Condltloi `s,;. Dumpsters,' protection, dust 4,600,00 4,500.00 containment, ..:. Floor Framing, Supply, install raised floor [approx 2,200 20,000.00 20,000.00 sq ft] and 3 ramps framed with engineered wood, glued and screwed 3/4 in ply. WaII Framing 15,000.flO 15,060.6 , Doors & Trim, excludes glass doors. 600.00 600.00 P,16 m b'-ir, Estimated . 6,000.00` :. 6,000 00- = Heating & Cooling, [Estimate ,ductwork only] 5,000.00 5,000.00 Electrical &Lighting, [Estimate] 17,500.00 17,50© 00 Tele/Data, [By others]. 0.00 0.00 Insulation :: 1,500.00 1,500 QO Interior Walls, Board. 7,500.00 7,500.00 Tape,,corhpound sand:. 15,000.00. A u 15,000 d0 Cabinets & Granite tops 7,500.00 7,500.00 S ecialtiesGara a Door 4,350.00 ' 4,350 00. Floor Coverings, [estimate] 25,000.00 w 25,000.00 Painting, No existing ductwork 8,000.00 8,000.00:,: Cleanup, Final Clean 500.00 500.00 Sprinkler Work 1,300.00 11300.00 Glass Doors [#7] /Panels Installed,[Approx 180 ft of 65,000.00 65,000.00 glass walls].One storefront entry door. supervision:,,, -, 21,205.00 ': 21,205;00' Insurance 2,120.50 2,120.50 Estimate for your review and approval . Total $235,375.50 Approved: (Initials) SIGNATURE 2 The Commonwealth of Massachusetts Department oflndustrialAccidents d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: � V (M- 16 r., TC<_. 6a tv .� 4ptpdy � �L t�-Ghon #: 17 J111 City/State/Zip: Are you an employer? Check the appropriate box: l.�am a employer with mployees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.F] I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] Ca Type of project (required): 7. ❑ New construction 8. f< Remodeling 9. ❑ Demolition 10 ❑ Building addition 11. ❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-cor traciors have employees,1liey must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company V,1+tJ,N C_ L -T 6r ei v love' V Policy # or Self -ins. Lie. #: W ( - 0 Expiration Date: 2r Job Site Address: .�� U I`t t `�`�� City/State/Zip: ONO aci�'k_I Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Phone #: t? I? ` Official use only: Do not write in this area, to be completed by city or town official City or Town: Permit/License # 2-A % (i Issuing Authority, (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, U4,02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia JKCON-1 OP ID: LK A4C®RD" OF LIABILITY INSURANCE DATE1CERTIFICATE 02/17/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DeSanctis insurance Agcy, Inc. 100 Unicorn781-935-$480_ Park Drive CONTACT NAME: _ PHONE A1CNo _, EML_ A No): 781-933-5645 Woburn, MA 01801 EMAIL ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # I INSURER A: Star Insurance Company 012245 � INSURED JK Contracting,—� Inc. 4 High Street Suite 108 North Andover, MA 01845 INSURER B:Selectiye Insurance Company 19259 INSURER C ----- INSURER D: INSURER E: r GENERAL AGGREGATE - $ 3,000,00 INSURER F: COVERAGES CERTIFICATE NUMBER: RFVISIr]N NI IMRFR- I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH -THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN ?VIAY HAVE BEEN REDUCED BY PAID CLAIMS. �INSRPOI CY EFr-POLICY EXP I LTR TYPE OF INSURANCE p!! L M 1 POLICY NUMBER MM/DWYYYY MMODD/YYYY LIMITS B X i COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR IS2205113 I ! 02/1012017 I 02/10/2018 EACH OCCURRENCE $ 1,000,00 ETOi��ED PREMISES Ea occurrence) $ 100,00 PREMISES MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'LAGGREGATE L LIMIT PER: I P � X POLICY JECT LOC r GENERAL AGGREGATE - $ 3,000,00 a PRODUCTS -COMPIOPAGG $ 3,000,00 $ OTHER: I kUTOMOSILE UABIUTY I COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED — SCHEDULED I AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS I I BODILY INJURY (Per accident) $ PROPETY DAMAGE $ (Per accRident) Is UMBRELLA UAB OCCUR EACH OCCURRENCE S { I EXCESS LIAB CLAIMS -MADE I I AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ! ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED'? L, N f A (Mandatory in NH) ; If yes, describe under I DESCRIPTION OF OPERATIONS below_ !WC0853742 ! IMA 1 02117/2017 02/17/2018 v j PER )TH- ;STATUTE I ER E.L. EACH ACCIDENT $ 100 00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT S 500,00 p 1 l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tACORD 101, Additional Remarks Schedule, may be attached if more space is requirod', - I°"ADDITIONAL INSURED LIMITS ARE NO GREATER o IRAN THOSE REQUIRED BY WRITTEN ICONTRACT" Illustration of Coverage; Town of North Andover is add'I insA as respects to the GL policy. I t NORTHA- Town of North Andover r 43 High Street N. Andover, MA 01845 SHOULD ANY OF THE AEOVE DESCRiE?ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD W I Massachusetts Department of Public Safety Board of Building Regulations and Standards 'License: CS -066334 ! Construction Supervisor KIERAN T WHELAN` r 31 RICHMOND STR a WEYMOUTH MA; 02188 I 1, C�, "' Expiration: Cornm•issioner 09126126*17 ,� ^%fir i%nurinai,rnc>rzl(� c f'>�L�ri.:,;ur�rrrc//� ' Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 171393 Type: Expiration: . 3/15/201:8 Individual r. KIERAN WHELAN KIERAN WHELAN i 31 RICHMOND ST WEYMOUTH, MA 02188 Undersecretary License or registration valid for i4dividgal .lise only :�efore the expiration date. If found return to: C'!fice of Consumer Affairs and Business Regulation. 1.0 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature JLie `�niianzo-�e.rue�rll� o�l�C�/�iaJ:rnefcisc:�d• Office,of Ca 4.siuiaer Affairs & Business Regulation z HOME IMPROVEMENT.•CO,NTIiACTOR Ex irationr -:"3. a18 Corporation 1. JK CONTRACTING LLC-;> - s KIERAN WHELAN 31: RICHMOND ST VVlEYMOUTH, MA 02188 Undersecretary